Postprandial hyperglycemia as a risk factor for cardiovascular disease. Therapy improves prognosis [Postprandiale hyperglykämie als risikofaktor bei herz-kreislauf- erkrankungen. Therapie verbessert prognose]

Diabetes is a cardiovascular disease, however, up to two decades ago there was no evidence that hyperglycemia itself is an independent risk factor. However consistent data from recently published prospective studies in subjects with impaired glucose tolerance and patients with early type 2 diabetes prove that postprandial/postchallenge hyperglycemia is an important risk factor for cardiovascular disease. Pathophysiological investigations have shown that excessive postprandial hyperglycemia causes a cascade of proatherogenic abnormalities such as oxidative stress, activation of NFκB receptor and impaired NO release of the endothelium. Moreover in the last years intervention studies like DIGAMI and a study in critical ill patients have shown that strict normalization of blood glucose control improves life expectancy in seriously ill patients. There are now three studies: STOP-NIDDM, MERIA and IMT study of the common carotid arteries which impressively demonstrate that control of postprandial hyperglycemia may prevent cardiovascular complications to the same degree as reported for statins and AC-inhibitors. Thus control of the glucose trias - HbA1c, postprandial and fasting plasma glucoses is essentially practice in patients with cardiovascular disease.